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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601246
Report Date: 06/20/2022
Date Signed: 06/20/2022 10:58:52 AM

Document Has Been Signed on 06/20/2022 10:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CLIMB, INC. - ARF 4FACILITY NUMBER:
198601246
ADMINISTRATOR:ANNETTE KYAMPAIREFACILITY TYPE:
735
ADDRESS:2315 S. STRANAHAN DRTELEPHONE:
(626) 281-8441
CITY:ALHAMBRASTATE: CAZIP CODE:
91803
CAPACITY: 4CENSUS: 4DATE:
06/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Angelica Flores, StaffTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the Infection Control domain. LPA met with Staff, Angelica Flores, who allowed entry and the purpose of the visit was explained. Administrator, Annette Kyampaire arrived at 9:15am to assist with the inspection. The facility is licensed to serve 4 non-ambulatory developmentally disabled clients age 18 to 59.

LPA toured the facility and observed the following:
* There are 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. There are no pools or bodies of water.
* Coronavirus (COVID-19) signage are posted at the main entry and around the house. Hand washing signs are posted in each of the bathrooms and sink.
* Staff are screening all visitors and documenting their temperature.
* PPE supplies for at least 30 days are observed.
* Food supplies for 2 day perishable and a week of non-perishable were observed.
* Knives and cleaning solutions are stored and locked making them inaccessible to clients.
* Smoke detectors and a carbon monoxide detector were tested and operable.
* The hot water temperature was measured between the required range of 105-120 degrees Fahrenheit.
* The fire extinguisher was last inspected on 4/6/22.
* All staff on duty were wearing face masks.
* Medications are centrally stored and locked in the kitchen cabinet. LPA reviewed all 4 clients' medications and staff are administering them as prescribed.

LPA provided a technical advisory for the N95 Respirator Fit Testing.

No deficiencies were observed during the visit today. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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